observing

The other day I got to watch the chief doing a laparoscopic cholecystectomy (gallbladder removal). For him it was easy. He only took the case because going in we were concerned about a lof of inflammation and scarring, which turned out not to be there.

As a student, when I watched laparoscopic cases, there was a fair amount of boredom involved. On one hand, I could see everything much more clearly than during an open case, when only the two people directly operating can actually see what’s happening, and not always easily even then. On the other hand, I have a strong propensity for falling asleep whenever the ambient lighting falls below a certain level; even holding the camera didn’t always keep me from drifting off.

Now that I’ve done a [very] few lap choles myself, it’s another story. I was very interested to watch the chief’s every step: how smoothly he peeled the gallbladder off the liver, and swept away the adhesions, how precisely he dissected down to the cystic duct and artery. No wasted steps, no fumbling – every move went exactly where he intended and moved the procedure forwards.

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One of my patients last week was just about perfect: young enough to recover very quickly, with a disease that absolutely warranted surgery, but shouldn’t affect her much once she’s gotten over the surgery. Her family was supportive, practically living in the hospital, attentive, but not smothering. She herself asked intelligent questions, exactly the things she needs to know and ought to be concerned about, but not too many silly questions or impossible ones – and she seemed to understand the answers. We don’t often meet such ideal patients. Everything went smoothly in the hospital for her, and with as wonderful a family and an attitude as she has, I expect she’ll do very well at home, too.